title: Prevalence and severity of oral disease in adults with chronic kidney disease: a systematic review of observational studies.
abstract: BACKGROUND
  Oral disease may be increased in people with chronic kidney disease (CKD) and, due to associations with inflammation and malnutrition, represents a potential modifiable risk factor for cardiovascular disease and mortality. We summarized the prevalence of oral disease in adults with CKD and explored any association between oral disease and mortality.
  
  
  METHODS
  We used systematic review of observational studies evaluating oral health in adults with CKD identified in MEDLINE (through September 2012) without language restriction. We summarized prevalence and associations with all-cause and cardiovascular mortality using random-effects meta-analysis. We explored for sources of heterogeneity between studies using meta-regression.
  
  
  RESULTS
  Eighty-eight studies in 125 populations comprising 11 340 adults were eligible. Edentulism affected one in five adults with CKD Stage 5D (dialysis) {20.6% [95% confidence interval (CI), 16.4-25.6]}. Periodontitis was more common in CKD Stage 5D [56.8% (CI, 39.3-72.8)] than less severe CKD [31.6% (CI, 19.0-47.6)], although data linking periodontitis with premature death were scant. One-quarter of patients with CKD Stage 5D reported never brushing their teeth [25.6% (CI, 10.2-51.1)] and a minority used dental floss [11.4% (CI, 6.2-19.8)]; oral pain was reported by one-sixth [18.7% (CI, 8.8-35.4)], while half of patients experienced a dry mouth [48.4% (CI, 37.5-59.5)]. Data for kidney transplant recipients and CKD Stages 1-5 were limited.
  
  
  CONCLUSIONS
  Oral disease is common in adults with CKD, potentially reflects low use of preventative dental services, and may be an important determinant of health in this clinical setting.
authors.affiliation: Diaverum Medical Scientific Office, Bari, Italy.
authors.forename: Marinella
authors.initials: M
authors.lastname: Ruospo
authors.forename: Suetonia C
authors.initials: SC
authors.lastname: Palmer
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Craig
authors.forename: Giorgio
authors.initials: G
authors.lastname: Gentile
authors.forename: David W
authors.initials: DW
authors.lastname: Johnson
authors.forename: Pauline J
authors.initials: PJ
authors.lastname: Ford
authors.forename: Marcello
authors.initials: M
authors.lastname: Tonelli
authors.forename: Massimo
authors.initials: M
authors.lastname: Petruzzi
authors.forename: Michele
authors.initials: M
authors.lastname: De Benedittis
authors.forename: Giovanni F M
authors.initials: GF
authors.lastname: Strippoli
mesh_terms: D000328:Adult; D014943:Global Health; D006801:Humans; D009059:Mouth Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D064887:Observational Studies as Topic; D009909:Oral Health; D015995:Prevalence; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D012307:Risk Factors; D012720:Severity of Illness Index
keywords: chronic kidney disease; epidemiology; meta-analysis; oral health; periodontitis